Global Medical Cures™ | USA Chartbook on HealthCare for Blacks

Agency for Healthcare Research and Quality
Advancing Excellence in Health Care www.ahrq.gov
CHARTBOOK
ON
HEALTH CARE
FOR BLACKS
National Healthcare Quality and Disparities Report

This document is in the public domain and may be used and reprinted without permission.
Citation of the source is appreciated. Suggested citation: 2015 National Healthcare Quality and
Disparities Report chartbook on health care for Blacks. Rockville, MD: Agency for Healthcare
Research and Quality; February 2016. AHRQ Pub. No. 16-0015-1-EF .

2015 NATIONAL HEALTHCARE
QUALITY AND DISPARITIES REPORT
CHARTBOOK ON HEALTH CARE FOR BLACKS
U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
AHRQ Publication No. 16-0015-1-EF
February 2016
www.ahrq.gov/research/findings/nhqrdr/index.html

ACKNOWLEDGMENTS
The National Healthcare Quality and Disparities Report (NHQDR) is the product of collaboration among agencies
across the U.S. Department of Health and Human Services (HHS). Many individuals guided and contributed to this
report. Without their magnanimous support, the report would not have been possible.
Specifically, we thank:
HHS Chartbook on Health Care for Blacks Authors: Barbara Barton (lead author-AHRQ), Sebastiana Gianci,
Marcia Gomez (NIMHD), Ernest Moy (AHRQ), Atlang Mompe (SSS).
AHRQ Staff: Richard Kronick, Jeff Brady, Amy Helwig, Ernest Moy, Darryl Gray, Nancy Wilson, and Doreen
Bonnett.
HHS Interagency Workgroup for the NHQR/NHDR: Girma Alemu (HRSA), Chisara N. Asomugha (CMS),
Kirsten Beronio (ASPE), Nancy Breen (NCI), Sarah Bryce (HRSA), Miya Cain (ACF), Victoria Cargill (NIH),
Steven Clauser (NCI), Wayne Duffus (CDC), Olinda Gonzalez (SAMHSA), Kirk Greenway (IHS), Chris Haffer
(CMS-OMH) , Linda Harlan (NCI), Rebecca Hines (CDC-NCHS), Edwin Huff (CMS), Deloris Hunter (NIH), Sonja
Hutchins (CDC), Ruth Katz (ASPE), Tanya Telfair LeBlanc (CDC), Shari Ling (CMS), Darlene Marcoe (ACF),
Tracy Matthews (HRSA), Karen McDonnell (CMS), Curt Mueller (HRSA), Karen Nakano (CMS), Iran Naqvi
(HRSA), Ann Page (ASPE), Kimberly Proctor (CMS-OMH), D.E.B. Potter (ASPE), Asel Ryskulova (CDC-NCHS),
Adelle Simmons (ASPE), Alan Simon (CDC-NCHS), Marsha Smith (CMS), Caroline Taplin (ASPE), Emmanuel
Taylor (NCI), Sayeedha Uddin (CDC-NCHS), Nadarajen Vydelingum (NIH), Chastity Walker (CDC), Barbara
Wells (NHLBI), Valerie Welsh (OASH-OMH), and Tia Zeno (ASPE).
Data Support Contractor: Social & Scientific Systems.

National Healthcare Quality and Disparities Report | 1
HEALTH CARE FOR BLACKS
Goals of the Chartbook on Health Care for Blacks
 Commemorates the 30th Anniversary of the Report of the Secretary’s Task Force on Black
and Minority Health (Heckler Report)
 Highlights progress for Blacks on priorities of the Heckler Report
 Summarizes trends in health care disparities by race related to:
■ Access to health care.
■ Priorities of the National Quality Strategy (NQS).
Organization of the Chartbook on Health Care for Blacks
 Part of a series related to the National Healthcare Quality and Disparities Report (QDR).
 Organized into three parts:
■ Overviews of the QDR and the Black population, one of AHRQ’s priority populations
■ Summary of trends in health care for the Black population related to priorities of the
Heckler Report
■ Summary of trends in health care for the Black population related to access to health care
and NQS priorities
Terminology
Race
 For the sake of brevity, Blacks refers both to African Americans (U.S. born) and foreign-
born Blacks.
 Foreign-born Blacks represent a growing percentage of the population but most data sources
do not distinguish between U.S.- and foreign-born Blacks.
 In 2000 and later U.S. Census Bureau surveys:
 U.S.-born Blacks refer to people born in the United States, Puerto Rico, or other U.S.
territories and those born abroad to at least one parent who is a U.S. citizen.
 Foreign-born Blacks refer to people born outside the United States, Puerto Rico, or other
U.S. territories.
 Both terms refer to people whose race is Black or mixed Black, regardless of Hispanic origin.
 This terminology is used in 2000 and later U.S. Census Bureau surveys.
Source: American Community Survey and Puerto Rico Community Survey, 2013. 2013 Subject
Definitions. http://www.census.gov/programs-surveys/acs/technical-documentation/code-
lists.2013.html

Chartbook on Health Care for Blacks
2 | National Healthcare Quality and Disparities Report
Income
 The QDR’s income data comes in two formats which is a determinant of the diverse sources
of our data.
■ Poor, low income, middle income, and high income
■ Quartiles: Q1- Q4
 Poor is defined as having family income less than 100% of the Federal poverty level (FPL);
low income refers to income of 100% to 199% of the FPL; middle income refers to income
of 200% to 399% of the FPL; and high income refers to income of 400% of the FPL and
above. These are based on U.S. census poverty thresholds for each data year, which are used
for statistical purposes.
 Q1 represents the lowest income quartile and Q4 represents the highest income quartile based
on the median income of a patient’s ZIP Code of residence.
Disparities
 Comparisons in this chartbook are between Blacks and Whites whenever the data are
available.
 Some comparisons are between non-Hispanic Blacks and non-Hispanic Whites when those
are the only data available; the terms “Blacks” and “Whites” are still used in these cases.
Key Findings of the Chartbook on Health Care for Blacks
 Data on access to and quality of health care received by Blacks were available for almost all
measures tracked in the QDR.
 Among Heckler Report priorities, disparities in colorectal cancer care and diabetes care
presented major challenges for Blacks.
 Blacks have worse access to care although this is improving since the Affordable Care Act.
 Blacks receive poorer quality of care, especially on measures of as related to person
centeredness and care coordination.

Chartbook on Health Care for Blacks Part 1: Overviews of the Report and the Black Population
PART 1: OVERVIEWS OF THE REPORT AND THE
BLACK POPULATION
National Healthcare Quality and Disparities Report
This chartbook is part of a family of documents and tools that support the National Healthcare
Quality and Disparities Reports (QDR). The QDR includes annual reports to Congress mandated
in the Healthcare Research and Quality Act of 1999 (P.L. 106-129). These reports provide a
comprehensive overview of the quality of health care received by the general U.S. population
and disparities in care experienced by different racial, ethnic, and socioeconomic groups. The
purpose of the reports is to assess the performance of our health system and to identify areas of
strengths and weaknesses in the health care system along three main axes: access to health care,
quality of health care, and priorities of the National Quality Strategy.
The reports are based on more than 250 measures of quality and disparities covering a broad
array of health care services and settings. Data are from the 2015 QDR, generally reflecting
collection through 2014. The reports are produced with the help of an Interagency Work Group
led by the Agency for Healthcare Research and Quality (AHRQ) and submitted on behalf of the
Secretary of Health and Human Services (HHS).
Chartbook on Health Care for Blacks
 This chartbook includes summaries of trends in health care for Black populations related to:
■ Priorities of the Heckler Report
■ Access to health care
■ Priorities of the National Quality Strategy
 QDR Introduction and Methods contains information about methods used in the chartbook.
 A Data Query tool (http://nhqrnet.ahrq.gov/inhqrdr/data/query) provides access to all data
tables.
Key Metrics Used in Chartbooks
 Trends: Assesses the rate of change over time (typically 2002-2013) for a population
 Disparities: Assesses whether measure estimates for two populations differ at the most recent
time point
 Change in Disparities: Assesses whether the rates of change over time for two populations
differ
 Achievable Benchmarks: Defines a level of performance for a measure that has been attained
by the best performing States (top 10 percent)
In this chartbook Blacks are usually contrasted with Whites. To make text more concise, the
labels White and Black are used to refer to populations that are non-Hispanic Black and non-
Hispanic White, respectively. In addition, unless otherwise specified, Hispanics include all races.

Examples of successful interventions come from the AHRQ Health Care Innovations Exchange:
https://innovations.ahrq.gov/. See Introduction and Methods for more information about methods
used in the chartbook.
HHS Data Collection Standards for Race and Ethnicity, 2011
 The Affordable Care Act includes several provisions aimed at eliminating health disparities
in America. Section 4302 (Understanding health disparities: data collection and analysis)
focuses on the standardization, collection, analysis, and reporting of health disparities data.
Section 4302 requires the Secretary of Health and Human Services (HHS) to establish data
collection standards for race, ethnicity, sex, primary language, and disability status. Adopted
Are you of Hispanic, Latino/a, or Spanish origin? (One or more categories may be marked)
1. ____ No, not of Hispanic, Latino/a, or Spanish origin;
2. ____ Yes, Mexican, Mexican-American, Chicano/a;
3. ____ Yes, Puerto Rican;
4. ____ Yes, Cuban;
5. ____ Yes, another Hispanic, Latino/a, or Spanish origin
These categories roll up to the Hispanic or Latino category of the Office of Management and Budget (OMB)
standard.
What is your race? (One or more categories* may be selected)
1. ____White
2. ____Black or African American
3. ____American Indian or Alaska Native
These categories are part of the current OMB standard.
1. ____Asian Indian
2. ____Chinese
3. ____Filipino
4. ____Japanese
5. ____Korean
6. ____Vietnamese
7. ____Other Asian
These categories roll up to the Asian category of the OMB standard.
8. ____Native Hawaiian
9. ____Guamanian or Chamorro
10. ____Samoan
11. ____Other Pacific Islander
These categories roll up to the Native Hawaiian or Other Pacific Islander category of the OMB standard.

October 31, 2011, these data collection standards are to be used, to the extent practicable, in
HHS-sponsored population health surveys.
 The new data standards improve the quality of HHS data collection by building on the Office
of Management and Budget (OMB) minimum standard, including additional specificity as
well as categories that can be consolidated to the current OMB standard. For many large
HHS surveys, including the National Health Interview Survey, National Survey on Drug Use
and Health, and Medical Expenditure Panel Survey, slight differences in subcategories
limited the ability to compare racial and ethnic groups between surveys; the new standards
create uniform categories to facilitate these comparisons (Dorsey, et al., 2014).
Source: Sorsey R, Graham G, Glied S, et al. Implementing health reform: improved data
collection and the monitoring of health disparities. Annu Rev Public Health 2014;35:123-38.
Diversity of the U.S. Population
 According to the 2010 Census, Whites made up 72% of the population of the United States in
comparison to 83% in 1980 (see 1980 Census at
http://www2.census.gov/prod2/decennial/documents/1980/1980censusofpopu8011u_bw.pdf)
and 88% at the beginning of the 20th
century (see 1910 Census, available at
http://www.census.gov/prod/www/decennial.html).
Racial and Ethnic Makeup of the U.S. Population, 2010
Source: Humes KR, Jones NA, Ramirez RR. Overview of race and Hispanic origin: 2010. 2010 Census Briefs. Suitland, MD: U.S. Census Bureau;
March 2011. Publication No. C2010BR-02. http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf
72.4%
12.6%
0.9% 4.8%
0.2%
6.2%
2.9%
White Black
American Indian/Alaska Native Asian
Native Hawaiian/Pacific Islander Some Other Race
>1 Race
83.7%
16.3%
Non-Hispanic Hispanic
Racial and Ethnic Makeup of the U.S. Population, 2010
Source: Humes KR, Jones NA, Ramirez RR. Overview of race and Hispanic origin: 2010. 2010 Census Briefs. Suitland, MD: U.S. Census Bureau;
March 2011. Publication No. C2010BR-02. http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf
72.4%
12.6%
0.9% 4.8%
0.2%
6.2%
2.9%
White Black
American Indian/Alaska Native Asian
Native Hawaiian/Pacific Islander Some Other Race
>1 Race
83.7%
16.3%
Non-Hispanic Hispanic

 In 1980, minorities made up about 20% of the population in the United States, African
Americans being the largest minority group at 11.7%. In 2010, Hispanics were the largest
minority group, making up more than 16% of the total population, and African Americans
just under 13%.
Diversity of the Black Population in the United States
 Blacks in the United States are a diverse population and in 2013 included:
■ Total population (39.9 million)
■ Percent of the total population (12.6%)
■ U.S.-born Blacks (36.2 million)
■ Foreign-born Blacks (3.8 million)
 Jamaican (682,000)
 Haitian (586,000)
 Nigerian (226,000)
 Dominican (166,000)
 Other foreign-born Blacks include people from Ghana (147,000), Guyana (122,000),
Kenya (107,000), Liberia (83,000), Somalia (79,000), Mexico (70,000), Barbados
15 Largest Ancestries, United States, 2000
4
4.3
4.5
4.5
4.9
7.9
8.3
9
15.6
18.4
20.2
24.5
24.9
30.5
42.8
0 5 10 15 20 25 30 35 40 45
Swedish (1.4%)
Scotch-Irish (1.5%)
Norwegian (1.6%)
Dutch (1.6%)
Scottish (1.7%)
American Indian (2.8%)
French (3.0%)
Polish (3.2%)
Italian (5.6%)
Mexican (6.5%)
American (7.2%)
English (8.7%)
African American (8.8%)
Irish (10.8%)
German (15.2%)
Millions
Note: Data based on sample. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see
www.census.gov/prod/cen2000/doc/sf3.pdf.
15 Largest Ancestries, United States, 2000
4
4.3
4.5
4.5
4.9
7.9
8.3
9
15.6
18.4
20.2
24.5
24.9
30.5
42.8
0 5 10 15 20 25 30 35 40 45
Swedish (1.4%)
Scotch-Irish (1.5%)
Norwegian (1.6%)
Dutch (1.6%)
Scottish (1.7%)
American Indian (2.8%)
French (3.0%)
Polish (3.2%)
Italian (5.6%)
Mexican (6.5%)
American (7.2%)
English (8.7%)
African American (8.8%)
Irish (10.8%)
German (15.2%)
Millions
Note: Data based on sample. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see
www.census.gov/prod/cen2000/doc/sf3.pdf.

(51,000), Cameroon (48,000), Cuba (41,000), Sierra Leone (36,000), Grenada
(34,000), Eritrea (33,000), Panama (32,000), Belize (32,000), Sudan (30,000),
Bahamas (27,000), and England (22,000).
 Foreign-born Blacks include single-race blacks and multiple-race Blacks, regardless
of Hispanic origin.
 Foreign-born Black populations do not add up to the total foreign-born Black
population because regions with fewer Black immigrants, such as Asia, the Middle
East, and most of Europe were not included.
■ Hispanic Blacks (3.2 million)
Source: U.S. Census Bureau. American FactFinder.
http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_1YR
_B05003B&prodType=table and Anderson M. A rising share of the U.S. black population is
foreign born. Washington, DC: Pew Research Center; April 2015.
http://www.pewsocialtrends.org/2015/04/09/a-rising-share-of-the-u-s-black-population-is-
foreign-born
Distribution of the U.S. Black Population
Distribution of the U.S. Black Population, 2010
Source: U.S. Census Bureau. 2010 Census Summary File 1. Map generated from the Census Data Mapper at
http://www.census.gov/geo/maps-data/maps/datamapper.html.
Note: For information on confidentiality protection, nonsampling error, and definitions, see www.census.gov/prod/cen2010/doc/sf1.pdf.
Distribution of the U.S. Black Population, 2010
Source: U.S. Census Bureau. 2010 Census Summary File 1. Map generated from the Census Data Mapper at
http://www.census.gov/geo/maps-data/maps/datamapper.html.
Note: For information on confidentiality protection, nonsampling error, and definitions, see www.census.gov/prod/cen2010/doc/sf1.pdf.

 Blacks are the second largest minority population, following the Hispanic/Latino population.
In 2010, most Blacks lived in the South (55% of the U.S. Black population), while 36% of
the White population lived in the South.
 The 10 States with the largest Black population are Florida, Texas, New York, Georgia,
California, North Carolina, Illinois, Maryland, Virginia, and Ohio. Combined, these 10 States
represent 58% of the total Black population.
 Of the 10 largest places in the United States with 100,000 or more population, Detroit,
Michigan, had the largest percentage of Blacks (84%), followed by Jackson, Mississippi
(80%).
Projected Population Growth
 Between 2014 and 2060, the Black population is projected to increase moderately, from 13%
to 14% of the total population (data not shown).
 The U.S.-born Black population is not expected to change much over the next four decades.
Projected Growth of U.S.-Born Population Between
2014 and 2060
31.2
13.0
2.1
0.2
0.8
2.0
13.0
68.8
50.6
25.5
5.8
0.2
0.8
5.0
13.3
49.4
0 20 40 60 80 100
Minority
Hispanic
2+ Races
NHPI
AI/AN
Asian
Black
White
Percent
2060
2014
Key: AI/AN = American Indian Alaska Native; NHPI = Native Hawaiian and Pacific Islander.
Source: U.S. Census Bureau. Projections of the Size and Composition of the U.S. Population: 2014 to 2060. Population Estimates and
Projections. Current Population Reports, March 2015. http://www.census.gov/newsroom/press-releases/2015/cb15-tps16.html
Note: The percentages for each group in each year may not add to 100 due to rounding. Unless otherwise specified, race categories represent
race alone. Minority refers to everyone other than the non-Hispanic White alone population.
Projected Growth of U.S.-Born Population Between
2014 and 2060
31.2
13.0
2.1
0.2
0.8
2.0
13.0
68.8
50.6
25.5
5.8
0.2
0.8
5.0
13.3
49.4
0 20 40 60 80 100
Minority
Hispanic
2+ Races
NHPI
AI/AN
Asian
Black
White
Percent
2060
2014

 Between 2014 and 2060 the percentage of foreign-born Blacks is expected to increase from
8.1% in 2014 to 11.4% in 2060.
Projected Growth of Foreign-Born Population Between
2014 and 2060
81.2
45.8
1.1
0.3
0.1
25.8
8.1
18.8
81.2
41.6
1.0
0.3
0.1
26.8
11.4
18.8
0 20 40 60 80 100
Minority
Hispanic
2+ Races
NHPI
AI/AN
Asian
Black
White
Percent
2060
2014
Projected Growth of Foreign-Born Population Between
2014 and 2060
81.2
45.8
1.1
0.3
0.1
25.8
8.1
18.8
81.2
41.6
1.0
0.3
0.1
26.8
11.4
18.8
0 20 40 60 80 100
Minority
Hispanic
2+ Races
NHPI
AI/AN
Asian
Black
White
Percent
2060
2014

 The non-Hispanic Black older population was 4 million in 2014 and is projected to grow to
12 million by 2060. In 2014, Blacks made up 9% of the older population. By 2060, the
percentage of the older population that is Black is projected to grow to 12%.
 Centenarians: In 2014, there were 8,582 Blacks age 100 years and over (1,558 men and
7,024 women). They made up 12% of all centenarians.
 Residence: In 2013, more than half of older Blacks lived in eight States: New York
(331,114), Florida (286,438), Texas (255,362), Georgia (252,101), California (248,195),
North Carolina (221,725), Illinois (196,584), and Maryland (177,521).
 Self-Rated Health Status: During 2011-2013, 27% of both older Black men and older Black
women reported very good/excellent health status. Among older non-Hispanic Whites, this
figure was 45% for men and 47% for women. Positive health evaluations decline with age.
Among Black men ages 65-74, 31% reported very good/excellent health compared with 17%
among those age 85 and over. Similarly, among Black women, this rate declined from 30% at
ages 65-74 to 20% at age 85 and over.
Projected Growth of Older Black Population Between
2014 and 2060
0
2
4
6
8
10
12
14
16
2014 2020 2030 2040 2050 2060
Millions
Adults Age 65+
Source: Administration on Aging. A statistical profile of Black older Americans aged 65+.
http://www.aoa.acl.gov/Aging_Statistics/minority_aging/Facts-on-Black-Elderly-plain_format.aspx
Projected Growth of Older Black Population Between
2014 and 2060
0
2
4
6
8
10
12
14
16
2014 2020 2030 2040 2050 2060
Millions
Adults Age 65+
Source: Administration on Aging. A statistical profile of Black older Americans aged 65+.
http://www.aoa.acl.gov/Aging_Statistics/minority_aging/Facts-on-Black-Elderly-plain_format.aspx

 Chronic Conditions:
■ Most older people have at least one chronic condition and many have multiple conditions.
Some of the most frequently occurring conditions among older non-Hispanic Blacks in
2011-2013 were:
 Hypertension (85% in 2009-2012),
 Diagnosed arthritis (51%),
 All types of heart disease (27%),
 Diagnosed diabetes (39% in 2009-2012), and
 Cancer (17%).
■ The comparable figures for all older persons were: hypertension (71% in 2009-2012),
diagnosed arthritis (49%), all types of heart disease (31%), diagnosed diabetes (21% in
2009-2012), and cancer (25%).
 Access to Medical Care: In 2013, 34% of older Blacks had both Medicare and
supplementary private health insurance and 11% were covered by both Medicare and
Medicaid. In comparison, almost 50% of all older adults had both Medicare and
supplementary private health insurance and 6% were covered by both Medicare and
Medicaid. In 2011-2013, 4% of older non-Hispanic Blacks reported they had no usual source
of health care, the same as the percentage for all older Americans.
Health of the Black Population in the United States
 Health of Blacks is influenced by various social determinants, such as poverty, lack of access
to high-quality education, unemployment, unhealthy housing, unsafe neighborhoods, and
other cultural barriers.
■ Social determinants of health are economic and physical conditions in the environments
in which people are born, live, learn, work, play, worship, and age that affect a wide
range of health, functioning, and quality-of-life outcomes and risks.
 Blacks have higher rates of mortality than any other racial or ethnic group for 8 of the top 10
causes of death.
Source: Kelly RL. 2015 Kelly report: health disparities in America. https://cbcbraintrust-
kelly.house.gov/media-center/kelly-report

Chartbook on Health Care for Blacks Part 2: Trends in Priorities of the Heckler Report
PART 2: TRENDS IN PRIORITIES OF THE HECKLER REPORT
Report of the Secretary’s Task Force on Black and Minority Health
(Heckler Report)
The year 2015 marked the 30th anniversary of the Report of the
Secretary’s Task Force on Black and Minority Health (also
known as the Heckler Report), released in 1985 under the
leadership of then U.S. Department of Health and Human
Services (HHS) Secretary Margaret M. Heckler. The landmark
report marked the first convening of a group of health experts
by the U.S. government to conduct a comprehensive study of
racial and ethnic minority health and elevated minority health
onto a national stage.
The Heckler Report documented persistent health disparities
that accounted for 60,000 excess deaths each year and
synthesized ways to advance health equity. This marked the
beginning of a new era in addressing minority health issues, beginning with the creation of the
HHS Office of Minority Health in 1986 and leading up to the Affordable Care Act in 2010.
Black Population Before and After Heckler Report (Census Years 1980
and 2010)
 Census data on race:
■ Collected for more than two centuries
■ Did not include ethnic groups until the 1970s
■ Was not precisely defined for non-Whites
■ Was self-reported in 1980 and 2010
 Office of Management and Budget racial groups:
■ Defined five categories in 1997:
 White
 Black or African American
 American Indian or Alaska Native
 Asian
 Native Hawaiian
■ Added sixth category (Some Other Race) in 2010 and allowed people to identify more
than one race
 Question 6 of the 2010 Census regarding race had 15 different choices and respondents could
identify one or more choice.

 Historically, there has been undercounting of the population in key geographic areas,
particularly those with increased minority representation.
 Data from the 1980 and 2010 Census were used whenever possible for this section; data from
the Current Population Survey were used to depict a more updated view of the population
within these time periods (1985 and 2015) and are so noted.
U.S. Black Population, 1980 vs. 2010
1980 2010
Total population (millions) 26.5 38.9 (42.0)
Percentage of total population 11.7 12.6 (13.6)
Urban vs. rural (% of total) 13.5 vs 6.6 28.1 vs. 8.2
Regional Distribution (%)
South 53 56.5 (55.0)
Midwest 20 17.9 (18.1)
Northeast 18 16.8 (17.1)
West 9 8.8 (9.8)
2010 Source: The Black population: 2010. 2010 Census Briefs. Suitland, MD: U.S. Census Bureau; September
2011; for urban/rural data: Race & ethnicity in rural America. Rural Research Brief. Washington, DC: Housing
Assistance Council; April 2012. http://www.ruralhome.org/storage/research_notes/rrn-race-and-ethnicity-web.pdf
1980 Source: Demographic trends in the 20
th
century. Suitland, MD: U.S. Census Bureau; November 2002; for
urban/rural data: 1980 Census of Populations. Table 37. Summary of General Characteristics: 1980. U.S. Census
Bureau. http://www2.census.gov/prod2/decennial/documents/1980/1980censusofpopu8011u_bw.pdf
 African Americans or Blacks in the United States have undergone different definitions as a
racial/ethnic minority. Census data represent the most reliable and consistent data available;
however, methods and definitions of race, poverty, environment, and other categories have
changed over time. These different definitions make comparison of data challenging.
Information on all populations is provided in certain areas to best show how the African
American population is being affected.
 Total population data used were “Black only” reported in the 1980 census. For the 2010 data,
the first number represents “Black only” and the number in parentheses represents Black
alone or in combination with another race.
 According to the 1980 census definition, the urban population comprises all persons living in
places of 2,500 or more inhabitants incorporated as cities, villages, boroughs (except in
Alaska and New York), and towns (except in the New England States, New York, and
Wisconsin).

Geographic Distribution of the U.S. Black Population
Top 10 States With Largest Number of Blacks
Top 10 States With Largest Percentage of
Blacks
1980 2010 1980 2010
New York New York District of Columbia District of Columbia
California Florida Mississippi Mississippi
Illinois Texas Louisiana Louisiana
Georgia Georgia South Carolina Georgia
Texas California Georgia Maryland
Florida North Carolina Maryland South Carolina
Louisiana Illinois Alabama Alabama
North Carolina Maryland North Carolina North Carolina
Michigan Virginia Virginia Delaware
Ohio Louisiana Delaware Virginia
Source: Bureau of the Census. 1980 Census of population. Volume 1. Characteristics of the population. Chapter B.
General population characteristics. Part 1. United States summary. Washington, DC: Government Printing Office;
May 1983. Publication No. PC80-1-B1. http://www2.census.gov/prod2/decennial/documents/1980/
1980censusofpopu8011u_bw.pdf; Rastogi S, Johnson Td, Hoeffel EM, et al. The Black population: 2010. 2010 Census
Briefs. Suitland, MD: U.S. Census Bureau; September 2011. Publication No. C2010BR-06.
https://www.census.gov/prod/cen2010/briefs/c2010br-06.pdf
 According to the U.S. Census Bureau, Blacks live throughout the country, with the highest
concentration in the South (about 55%). In 2010, the District of Columbia had the largest
percentage of Blacks (51%), and Mississippi was second with 37%. New York had the
largest number of Black residents (3.1 million) although States in the South had a higher
percentage of Blacks.
 According to a report by the University of South Carolina (Probst, et al., 2002):
■ Seventy percent of poor Blacks in nonmetropolitan areas live in Mississippi, Georgia,
North Carolina, Louisiana, Alabama, and South Carolina.
■ “Rural poverty affects both individuals and communities. The proportion of poor persons
is higher among minority populations, and total community economic resources are more
constrained in communities where minority groups represent over half of the population.”
■ Thirty-four percent of the nonmetropolitan Black population is poor compared with 13%
of the nonmetropolitan White population.
■ In nonmetropolitan counties where the majority of the population is Black, the average
total county income is 67% of the national value, and bank deposits average 56% of the
value for majority White counties.

U.S. Black Population by Selected Characteristics, 1980 and 2010
1980 2010
Age (U.S. Census Bureau, 1983 and 2011)
Median Age 24.9 years 31.4 years
Under 18 35.4% 29.4%
18-64 56.8% 62.0%
65+ 7.8% 8.6%
Life Expectancy (Arias, 2015)
Total 68.1 75.1
Male 63.8 71.8
Female 72.5 78.0
Family Composition (U.S. Census Bureau, 1981; Lofquist, et al., 2012)
Married Couples 56% 28.5%
Female Head of Household 40% 30.1%
Income (U.S. Census Bureau, 1982; DeNavas-Walt & Proctor, 2015)
Median Household Income $10,674 (29,455) $34,882
Mean Household Income $13,970 (38,228) $48,817
% Below Federal Poverty Level 32.5 (all races, 13) 27.4 (all races, 15)
Business Ownership (Peters, 1987; U.S. Census Bureau, 2007)
Business Ownership 1.2% 7.0%
Education (U.S. Census Bureau, 1999 and 2012)
High School Graduate 51.2% (age 25+) 82%
College Graduate 8.4% (age 25+) 18.0%
 The percentage of female head of household with children under 18 years at home has
increased for all races since the 1950s. Blacks had the largest increase from the 1950s to the
present.
 Between 1970 and 1980 the percentage of Black women maintaining a household more than
doubled. In 1980, women first became eligible to be identified as “householder of a married
couple household”; since then, they have “…represented an increasing proportion of all
married couple householders for every race and Hispanic origin since 1980” (Hobbs &
Stoops, 2002).
 In 1950, 78% of Black families were married couples, compared with 56% in 1980 and
28.5% in 2010. In 2010, the percentage of Black families maintained by a single female was
30%. In 2010, nonfamily households represented 35% of Black households. Unmarried
couple households (opposite and same sex) could be family or nonfamily, depending on the
relationship of others in the household; these represented 7% of Black households.
 Blacks’ median income is under the level of all other racial and ethnic groups, including
Whites, Asian, and Hispanics.
 From 1960 to the present, Black-owned businesses have transitioned from predominantly
small personal service types (e.g., beauty salons, barber shops) to industrial types. The
business ownership rate for Blacks has been lower than for other racial and ethnic groups.
For example, in 1982, Blacks owned 12.1 firms per thousand, compared to 62.9 for Whites,
28.6 for Asians and 19.5 for Hispanics (Peters, 1987). In 2007, 7% of U.S. firms were owned
by Blacks, and 1.9% of U.S. firms with employees were owned by Blacks (U.S. Census
Bureau, 2007).
 “[B]usinesses owned by disadvantaged minorities tend to be smaller and less successful than
non-minority-owned businesses.” (Fairlie & Robb, 2008).

Health of the Black Population in the United States
Relative Risks and/or Prevalence
1980 2010
Hypertension Hypertension
Diabetes Overweight and obesity
Anemia Diabetes
Tuberculosis Complications during perinatal period
Homicide Asthma
Heart disease HIV/AIDS
Low birth weight Periodontitis
Top 10 Causes of Mortality in Blacks
1980 2010
Diseases of the heart Diseases of the heart
Malignant neoplasm Malignant neoplasm
Cerebrovascular diseases Cerebrovascular diseases
Unintentional injuries Diabetes mellitus
Homicide Unintentional injuries
Diseases originating in perinatal period Nephritis, nephrotic syndrome, and nephrosis
Pneumonia and influenza Chronic lower respiratory diseases
Diabetes mellitus Homicide
Chronic liver disease and cirrhosis Septicemia
Nephritis, nephrotic syndrome, and nephrosis Alzheimer’s disease
 A 2002 South Carolina University report indicated that “84% of counties where African
Americans are the majority of the population are HPSA’s [Health Professions Shortage
Areas]” (Probst, 2002). The 1985 Heckler report indicated, “Relative risks for specific causes
of death… are disturbingly high among Blacks compared to the White populations…Relative
risk does not indicate the largest numbers of deaths; rather, it reflects the comparative
likelihood of dying from a particular cause.” For Blacks, tuberculosis, hypertension,
homicide, and anemia were among the top life-limiting conditions. Diabetes was also
identified as a reason for increased morbidity among Blacks in the 1980s.
 In the early 1980s, HIV/AIDS was not well identified or diagnosed. In the 21st century, it
had high prevalence and is the 11th or 12th (depending on gender and age) leading cause of
death among Blacks. In 2010, 49% of all HIV-related death were among Blacks. In the
United States in 2011, the diagnosis rate of HIV/AIDS was 15.8 per 100,000, but among
Blacks this rate was 60.4. Of total HIV diagnoses made between 2008 and 2011, Blacks
made up 47% of the total, 64% of women, 66% of infections documented as heterosexual
contact, and 67% of children under age 13 years. Blacks diagnosed with HIV are less likely
to be linked to care, remain in care, or receive adequate treatment (CDC, 2014).

Historic Events Before and After the Heckler Report
 Blacks in the United States, including slaves, descendants of slaves, and other immigrants
have been an integral part of America’s history. They have been scientists, educators,
laborers, and leaders; they have been part of every major event or era in America’s history.
 After the Emancipation Proclamation by President Lincoln, they have also been essential to
the U.S. government. Since the 41st
Congress in 1869, there has been Black representation in
Congress, mostly in the House of Representatives.
 Three Senators were elected in the period before the Heckler report, and six Senators have
been elected since. The first Black female Senator was elected for the 103rd
Congress in
1993.
 Several Black Supreme Court Justices have been appointed, the first by President Johnson in
1967, the Court's 96th
Justice. Another Black Justice was appointed in 1991.
 The first Black President was elected in 2008.
Major Accomplishments, Challenges, Significant Moments in History Prior to Heckler
Report
 Blood bank invention by a Black physician, surgeon, and medical researcher
 1961 – Affirmative Action. Executive Order 10925 by President Kennedy to ensure
contractors are treated equally, without regard to race, creed, color, or national origin
 1965 – Executive Order 11246 by President Johnson to prevent discrimination by
organizations receiving Federal funding
 1965 – Passage of Civil Rights legislation ending segregation
 1967 – First Black Supreme Court Justice appointed by President Johnson.
 U.S. Congress – More than 50 Blacks elected to the U.S. House of Representatives and 3
elected to the Senate
Major Accomplishments, Challenges, Significant Moments in History After Heckler
Report
 More than 100 additional Blacks have been elected to Congress, including 6 Senators,
among them the first female Black Senator, elected in 1993 (remaining members were
elected to the House of Representatives).
 1992 – First Black woman to travel in space was an American physician and NASA
astronaut.
 2008 – First Black President of the United States was elected.
 Healthy People 2010 and 2020 reported gaps in health for Blacks, which persist and in
some cases widen.
 2010 – Affordable Care Act was passed, providing health insurance to many people not
previously insured, including a large percentage of Blacks.

Priorities of the Heckler Report
 The Heckler Report found that six causes of death accounted for more than 80% of mortality
among Blacks and other minority groups compared with Whites. These include cancer;
cardiovascular disease and stroke; chemical dependency (measured by deaths due to
cirrhosis); diabetes; homicide and accidents (unintentional injuries); and infant mortality.
Based on the findings, the report outlined recommendations in areas of urgent need,
including health information and education; health services delivery and financing; health
professions development; data development; and research agenda.
 Data on “other minorities,” including Hispanics:
■ Was very limited in the 1980s.
■ Is much more available today.
 With the rapidly increasing diversity of the Nation and persistence of health disparities, the
Heckler Report 30th anniversary serves as a call for all Americans to take action and
accelerate efforts toward ending health disparities and achieving health equity in their
community.
Progress on Priorities of the Heckler Report for Blacks
Priority Trends
Most Recent
Disparity Disparity Change
Care for Cancer 71% Improving 50% Worse 67% Narrowing
Care for Cardiovascular Diseases 78% Improving 33% Worse No Change
Care for Substance Use
Disorders
No Improvement No Disparity No Change
Care for Diabetes 25% Improving 78% Worse 67% Narrowing
Suicide Prevention and Mental
Health Care
33% Worsening 75% Worse No Change
Infant Mortality and Maternity
Care
100% Improving 33% Better No Change
 Trends:
■ All measures for infant mortality and maternity care and most measures of care for cancer
and care for cardiovascular diseases were improving for Blacks.
■ No measures of care for substance use disorders were improving and suicide prevention
seemed to be getting worse for Blacks.
 Groups With Disparities:
■ For many measures of care for mental health disorders, diabetes, and infant mortality,
Blacks received worse quality of care than Whites. Blacks tended to receive better quality
of maternity care.
■ Of measures for which Blacks received worse quality of care than Whites, narrowing of
the gap was observed for several measures of cancer and diabetes care. No narrowing of
disparities was observed among measures of cardiovascular and mental health care.

 Summary: Of priorities in the Heckler Report:
■ Suicide prevention and mental health care for Blacks is worsening, with many disparities
and no reductions in disparities over time.
■ Blacks also experience many disparities in care for diabetes.
■ Care for substance use disorders is poor for all ethnic groups.
Care for Cancer
 Thirty years ago, the Heckler Report found that:
■ Overall age-adjusted cancer incidence rates for Blacks were higher than for Whites or
minorities. Specific sites of excess incidence among Blacks were the stomach, prostate,
esophagus, pancreas, and cervix.
■ The overall 5-year relative survival rate of Blacks was lower than that of Whites.
 In addition, quality care for cancer has changed. Evidence-based mass screening is
recommended in specific populations for four cancers: breast, cervical, colorectal, and lung
cancer. Screening is the first step in the process of cancer prevention (Pap testing for cervical
and colonoscopy for colorectal) and early detection (mammography for breast and CT scan
for lung) in the process of cancer control. Thus, cancers amenable to screening are included
in this chartbook.
Breast Cancer Care for Blacks
Measure
Most Recent
Women ages 50-74 who received a mammogram in the last
2 years
Same No Change
Breast cancer diagnosed at advanced stage per 100,000
women age 40+
Worse Growing
Women with clinical Stage I-IIb breast cancer who received
axillary node dissection or sentinel lymph node biopsy at
the time of surgery
Same No Change
Women under age 70 treated for breast cancer with breast-
conserving surgery who received radiation therapy to the
breast within 1 year of diagnosis
Same Narrowing
Breast cancer deaths per 100,000 female population per
year
Worse No Change
 Trends: Most measures of breast cancer care for Blacks were improving.
■ Rates of mammography were similar between Black and White women. This disparity
did not change over time.
■ Rates of diagnosis with advanced stage breast cancer were worse for Blacks compared
with Whites and these disparities worsened over time.

■ Rates of women with clinical Stage I-IIb breast cancer who received axillary node
dissection at time of surgery were similar between Black and White women. This
disparity did not change over time.
■ Rates of women who received radiation therapy after breast-conserving surgery were
similar between Black and White women, and this disparity narrowed over time.
■ Breast cancer death rates were worse for Blacks compared with Whites. This disparity
did not change over time.
Breast Cancer Surgery and Radiation
 Importance: Radiation therapy after breast-conserving surgery reduces the risk of cancer
recurrence and death.
 Trends: From 2004 to 2011, the percentage of women with breast-conserving surgery who
received radiation therapy to the breast improved overall and for Blacks and Hispanics.
■ In 7 of 9 years, Black and Hispanic women were less likely to receive radiation therapy
to the breast compared with White women.
■ In 2012, Black women with public insurance (80.3%) were less likely than those with
private insurance (85.3%) to receive radiation therapy to the breast.
Women under age 70 treated for breast cancer with breast-conserving surgery who
received radiation therapy to the breast within 1 year of diagnosis, by race/ethnicity,
2004-2012, and by insurance, Blacks under age 65, 2012
50
60
70
80
90
100
Percent
Total White Black Hispanic
50
60
70
80
90
100
2012
Percent
Black
Private Public Uninsured
2008 Achievable Benchmark: 95%
Source: Commission on Cancer, American College of Surgeons and American Cancer Society, National Cancer Data Base, 2004-2012.
Denominator: Women under age 70 treated for breast cancer with breast-conserving surgery.
Note: Black and White are non-Hispanic. Hispanic includes all races.
Women under age 70 treated for breast cancer with breast-conserving surgery who
received radiation therapy to the breast within 1 year of diagnosis, by race/ethnicity,
2004-2012, and by insurance, Blacks under age 65, 2012
50
60
70
80
90
100
Percent
50
60
70
80
90
100
2012
Percent
Black
Denominator: Women under age 70 treated for breast cancer with breast-conserving surgery.

 Achievable Benchmark:
■ The 2008 top 5 State achievable benchmark was 95%. The top 5 States that contributed to
the achievable benchmark are Kansas, Minnesota, Montana, New Hampshire, and
Wisconsin.
■ At the current rates of improvement, the benchmark could be achieved overall within 9
years.
■ At the current rates of improvement, Blacks and Hispanics would need 11 and 12 years,
respectively, to reach the benchmark. Whites are moving away from the benchmark.
Colorectal Cancer Care for Blacks
Measure
Most Recent
Men and women ages 50-75 who report that they had a
blood stool test in the past year, sigmoidoscopy in the past
5 years and blood stool test in the past 3 years, or
colonoscopy in the past 10 years
Same No Change
Colorectal cancer diagnosed at advanced stage per
100,000 men and women age 50 and over
Worse No Change
Patients with colon cancer who received surgical resection
of colon cancer that included at least 12 lymph nodes
pathologically examined
Worse No Change
Colorectal cancer deaths per 100,000 population per year Worse No Change
 Trends: All measures of colorectal cancer care for Blacks were improving.
■ Rates for colorectal cancer screening were similar between Blacks and Whites. This
disparity did not change over time.
■ Rates of diagnosis with advanced stage colorectal cancer, surgical resection of colon
cancer that included at least 12 lymph nodes pathologically examined, and deaths due to
colorectal cancer were worse for Blacks compared with Whites. These disparities were
not changing over time.

Colorectal Cancer Screening
 Importance: Screening can detect abnormal colorectal growths before they develop into
cancer. Early detection increases treatment options and the chances for cure. Effective
screening modalities include fecal occult blood testing (FOBT), FOBT with flexible
sigmoidoscopy, and colonoscopy.
 Trends: From 2000 to 2013, the percentage of adults ages 50-75 who received appropriate
colorectal cancer screening increased overall (from 34.1% to 58.2%) and among all
racial/ethnic groups.
■ In 5 of 6 years, the percentage of adults who received appropriate colorectal cancer
screening was lower among Asians compared with Whites.
■ In 3 of 6 years, the percentage of adults who received appropriate colorectal cancer
screening was lower among Blacks compared with Whites.
■ In 2013, the percentage of adults who received appropriate colorectal cancer screening
was lower among poor (47.6%), low-income (51.5%), and middle income (61.7%)
Blacks compared with high-income Blacks (71.6%).
Adults ages 50-75 who report that they had appropriate colorectal cancer screening,
by race, 2000-2013, and by family income, Blacks, 2013
0
20
40
60
80
100
2000 2003 2005 2008 2010 2013
Percent
Total White Black
Asian AI/AN >1 Race
0
20
40
60
80
100
2013
Percent
Black
Poor Low Income
Middle Income High Income
Key: AI/AN = American Indian or Alaska Native.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2000-2013.
Denominator: Adults ages 50-75.
Note: Measure is age adjusted. Data for AI/AN in 2003 were statistically unreliable.
Adults ages 50-75 who report that they had appropriate colorectal cancer screening,
by race, 2000-2013, and by family income, Blacks, 2013
0
20
40
60
80
100
2000 2003 2005 2008 2010 2013
Percent
Total White Black
Asian AI/AN >1 Race
0
20
40
60
80
100
2013
Percent
Black
Poor Low Income
Denominator: Adults ages 50-75.
Note: Measure is age adjusted. Data for AI/AN in 2003 were statistically unreliable.

Surgical Resection of Colon Cancer
 Importance: Recommended cancer treatment depends on different factors, such as the stage
or extent of the cancer within the body, especially whether the disease has spread from the
original site to other parts of the body. Colon cancer typically begins as a benign polyp that
may become cancerous and then spread to local lymph nodes. Hence, ensuring adequate
examination of lymph nodes when surgery is performed is important.
 Trends: From 2004 to 2012, the percentage of patients with colon cancer who received
surgical resection of colon cancer that included at least 12 lymph nodes pathologically
examined improved overall (55.4% to 88.2%) and for all racial/ethnic groups.
■ From 2004 to 2012, there were almost no statistically significant differences between
racial/ethnic groups in the percentage of patients with colon cancer who received surgical
resection of colon cancer that included at least 12 lymph nodes pathologically examined.
In 2 years, Blacks were less likely than Whites to receive surgery, and in 1 year,
Hispanics were less likely than Whites to receive surgery.
■ In 2012, the percentage of patients with colon cancer who received surgical resection of
colon cancer that included at least 12 lymph nodes pathologically examined was lower
Patients with colon cancer who received surgical resection of colon cancer that
included at least 12 lymph nodes pathologically examined, by race/ethnicity, 2004-
2012, and by family income, Blacks, 2012
50
60
70
80
90
100
Percent
50
60
70
80
90
100
2012
Percent
Black
Poor Low Income
Denominator: People with colon cancer undergoing resection of colon.
Patients with colon cancer who received surgical resection of colon cancer that
included at least 12 lymph nodes pathologically examined, by race/ethnicity, 2004-
2012, and by family income, Blacks, 2012
50
60
70
80
90
100
Percent
50
60
70
80
90
100
2012
Percent
Black
Poor Low Income
Denominator: People with colon cancer undergoing resection of colon.

among poor (87.7%) and low-income (86.5%) Blacks compared with high-income Blacks
(96.6%).
the achievable benchmark are Delaware, Missouri, Utah, Vermont, and Wisconsin.
■ At the current rates of improvement, the achievable benchmark could be attained overall
and for all racial/ethnic groups within a year.
Other Cancer Care for Blacks
Measure
Most Recent
All cancer deaths per 100,000 population per year Worse No Change
Women ages 21-65 who received a Pap smear in the
last 3 years
Same No Change
Invasive cervical cancer incidence per 100,000 women
age 20 and over
Worse Narrowing
Men age 75+ without prostate cancer who had a PSA
test or digital rectal exam for prostate cancer screening
within the past year
Same No Change
Lung cancer deaths per 100,000 population per year Same No Change
 Trends: Most measures of other cancer care for Blacks were improving.
■ Death rates were higher among Blacks compared with Whites and were not changing
over time.
■ Blacks were more likely to develop invasive cervical cancer compared with Whites. This
disparity was narrowing over time.
■ Rates among Blacks and Whites were similar for Pap smears, prostate cancer screening,
and lung cancer deaths and these disparities were not changing over time.

Pap Smears
 Importance: Screening with Pap smears can detect high-grade precancerous cervical lesions
that can be removed before they become cancerous.
 Trends: From 2000 to 2013, the percentage of women ages 21-65 who received a Pap smear
in the last 3 years decreased overall (87.5% to 80.7%) and for Whites (88.1% to 81.4%) and
Blacks (90.3% to 82.2%).
■ In all years, the percentage of women who received a Pap smear was lower among Asian
women compared with White women. The disparities between Asians and American
Indians/Alaska Natives (AI/ANs) and Whites are narrowing. This is due to a decline in
the White rates.
■ In 2013, uninsured Black women (65.8%) were less likely to receive a Pap smear
compared with Black women with private insurance (88.2%).
Women ages 21-65 who received a Pap smear in the last 3 years, by race,
2000-2013, and by insurance, Blacks, 2013
50
60
70
80
90
100
2000 2005 2008 2010 2013
Percent
Total White Black
Asian AI/AN >1 Race
50
60
70
80
90
100
2013
Percent
Black
Denominator: Women ages 21-65.
Note: Measure is age adjusted. Racial groups refer to single race (e.g., White only).
Women ages 21-65 who received a Pap smear in the last 3 years, by race,
2000-2013, and by insurance, Blacks, 2013
50
60
70
80
90
100
2000 2005 2008 2010 2013
Percent
Total White Black
Asian AI/AN >1 Race
50
60
70
80
90
100
2013
Percent
Black
Denominator: Women ages 21-65.

the achievable benchmark are Delaware, District of Columbia, Massachusetts, Rhode
Island, and Vermont.
■ The total and all racial/ethnic groups except AI/ANs are moving away from the
achievable benchmark. AI/ANs could achieve the benchmark, although it would take 22
years.
AHRQ Health Care Innovations in Cancer Screening
Contra Costa Breast Cancer Partnership
 Location: Contra Costa County, California
 Population: Low-income minority women, particularly Black women, age 40 and over
 Intervention: Contra Costa Breast Cancer Partnership aimed to reduce disparities in breast
cancer-related health outcomes by developing culturally appropriate outreach and education
designed to reduce the stigma surrounding breast cancer, encourage screening, and secure
access to affordable treatment.
 Outcomes: Enhanced access to breast cancer screening and earlier detection of breast cancer
among Black and Hispanic women.
Care for Cardiovascular Diseases
■ Cardiovascular disease (CVD) was a major cause of death in Blacks, and the rate was
higher than in Whites.
■ There appeared to be a strong inverse relationship between socioeconomic status (SES)
and hypertension in Blacks, similar to that found for Hispanics and Whites.
■ Diabetes mellitus was a major problem in Blacks.
■ The generally higher prevalence of obesity, noninsulin-dependent diabetes, hypertension,
high low-density lipoprotein (LDL) cholesterol and low high-density lipoprotein (HDL)
cholesterol levels in Blacks might be expected to increase their CVD risk.
Cardiovascular Care for Blacks
Measure
Most Recent
Disparity
Disparity
Change
Adults who received a blood pressure measurement in the last
2 years and can state whether their blood pressure was
normal or high
Same No Change
Adult admissions for hypertension Same No Change
Adult admissions for angina without cardiac procedure Worse No Change
Adult admissions for congestive heart failure Worse No Change
Hospital patients with heart attack given fibrinolytic medication
within 30 minutes of arrival
Same No Change

 Trends: Most measures of cardiovascular care for Blacks were improving.
■ The rates between Blacks and Whites were similar for those who received their blood
pressure measurement and for hypertension admissions. These disparities did not change
over time.
■ Blacks had higher rates of admission than Whites for angina and congestive heart failure
and these disparities did not change over time.
■ Blacks and Whites had similar rates of receipt of fibrinolytic medication for heart attack
and these disparities did not change over time.
Blood Pressure Measurement
 Importance: Early detection and treatment of high blood pressure can prevent heart failure,
kidney failure, and stroke. Because high blood pressure typically causes no symptoms,
screening is essential.
 Trends: From 1998 to 2012, the percentage of adults who received a blood pressure
measurement in the last 2 years and can state whether their blood pressure was normal or
high did not change overall or for any racial/ethnic group.
Adults who received a blood pressure measurement in the last 2 years and can state
whether their blood pressure was normal or high, by race, 1998-2012, and by
insurance, Blacks, 2012
50
60
70
80
90
100
1998 2003 2008 2012
Percent
Total White Black
Asian AI/AN
50
60
70
80
90
100
2012
Percent
Black
Denominator: Adult civilian noninstitutionalized population.
Adults who received a blood pressure measurement in the last 2 years and can state
whether their blood pressure was normal or high, by race, 1998-2012, and by
insurance, Blacks, 2012
50
60
70
80
90
100
1998 2003 2008 2012
Percent
Total White Black
Asian AI/AN
50
60
70
80
90
100
2012
Percent
Black
Denominator: Adult civilian noninstitutionalized population.

■ In 2 of 4 years, Black adults were more likely than Whites to receive a blood pressure
measurement. In 2 of 4 years, Asian adults were less likely than Whites to receive a blood
pressure measurement.
■ In 2012, uninsured Black adults (81.5%) were less likely than Black adults with private
insurance (93.9%) to receive a blood pressure measurement.
Admissions for Congestive Heart Failure
 Importance: Racial disparities in care for congestive heart failure have been observed.
 Trends: From 2002 to 2013, the rate of admission for congestive heart failure among adults
decreased significantly for all racial/ethnic groups.
■ In all years, compared with Whites, Blacks had higher rates of admission for congestive
heart failure. In 10 of 12 years, the rates of admission for congestive heart failure were
higher among Hispanics compared with Whites.
■ In 2013, poor (851.1 per 100,000) and low-income (707.0 per 100,000) Black adults had
higher rates of admission for congestive heart failure compared with Black adults with
high income (544.7 per 100,000).
0
200
400
600
800
1,000
1,200
Rateper100,000Population
White Black Hispanic
Adult admissions for congestive heart failure per 100,000 population, by race,
2001-2013, and by area income, Blacks, 2013
0
200
400
600
800
1,000
1,200
2013
Black
Q1 (Lowest) Q2 Q3 Q4 (Highest)
2008 Achievable Benchmark:
182 Admissions per 100,000
Population
Key: Q1 represents the lowest income quartile and Q4 represents the highest income quartile based on the median income of a patient’s ZIP
Code of residence.
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, State Inpatient Databases, 2001‐2013 quality
and disparities analysis files and AHRQ Quality Indicators, modified version 4.4.
Denominator: U.S. resident population age 18 and over.
Note: For this measure, lower rates are better. White and Black are non-Hispanic. Hispanic includes all races.
2008 Achievable Benchmark: 182 Admissions
per 100,000 Population
0
200
400
600
800
1,000
1,200
Adult admissions for congestive heart failure per 100,000 population, by race,
2001-2013, and by area income, Blacks, 2013
0
200
400
600
800
1,000
1,200
2013
Black
2008 Achievable Benchmark:
182 Admissions per 100,000
Population
Code of residence.
Note: For this measure, lower rates are better. White and Black are non-Hispanic. Hispanic includes all races.
2008 Achievable Benchmark: 182 Admissions
per 100,000 Population

■ The 2008 top 4 State achievable benchmark for adult congestive heart failure admissions
was 182 admissions per 100,000 population. The top 4 States that contributed to the
achievable benchmark are Colorado, Utah, Vermont, and Wyoming.
■ At current rates of improvement, it would take the overall rate 10 years to achieve the
benchmark, Blacks could achieve the benchmark in 15 years, Whites could achieve it in 7
years, and Hispanics would need 6 years to achieve the benchmark.
Heart Attack Patients Given Fibrinolytic Medication
 Importance: Some heart attacks are caused by blood clots. Early actions, such as fibrinolytic
medication, may open blockages caused by blood clots, reduce heart muscle damage, and
save lives. To be effective, these actions need to be performed quickly after the start of a
heart attack.
 Trends: From 2005 to 2013, the percentage of patients who received timely fibrinolytic
medication improved overall (27.7% to 51.4%).
 Groups With Disparities: In 6 of 9 years, the percentage of patients who received timely
fibrinolytic medication was lower for Blacks than for Whites.
within 30 minutes of arrival, by race, 2005-2013
0
20
40
60
80
100
2005 2006 2007 2008 2009 2010 2011 2012 2013
Percent
Total White Black
Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2005-2013.
Denominator: Discharged hospital patients with a principal diagnosis of acute myocardial infarction and documented receipt of thrombolytic
therapy during the hospital stay.
within 30 minutes of arrival, by race, 2005-2013
0
20
40
60
80
100
2005 2006 2007 2008 2009 2010 2011 2012 2013
Percent
Total White Black
Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2005-2013.
Denominator: Discharged hospital patients with a principal diagnosis of acute myocardial infarction and documented receipt of thrombolytic
therapy during the hospital stay.

Outcomes of Cardiovascular Care for Blacks
Measure
Most Recent
Deaths per 1,000 hospital admissions with acute myocardial
infarction (AMI), age 18+
Better No Change
Deaths per 1,000 hospital admissions with congestive heart
failure (CHF), age 18+
Better No Change
Deaths per 1,000 hospital admissions with abdominal aortic
aneurysm repair, age 18+
Better Narrowing
Deaths per 1,000 hospital admissions with coronary artery
bypass graft, age 40+
Same No Change
Deaths per 1,000 hospital admissions with percutaneous
transluminal coronary angioplasty, age 40+
Better No Change
 Trends: Most measures of cardiovascular-related deaths among Blacks were improving.
■ The death rates for Blacks were better compared with Whites when hospitalized for:
 Acute myocardial infarction.
 Congestive heart failure.
 Abdominal aortic aneurysm repair.
 Percutaneous transluminal coronary angioplasty.
■ The death rates for Blacks and Whites were similar for hospital admissions with coronary
artery bypass graft. This disparity did not change over time.
■ The disparities between Blacks and Whites did not change over time for all measures
except deaths per 1,000 hospital admissions for abdominal aortic aneurysm repair, which
narrowed.

Inpatient Deaths Among Adult Admissions With Heart Attack
 Importance: Racial disparities in heart attack care have been observed.
 Trends: From 2001 to 2013, the risk-adjusted inpatient mortality rate for hospital admissions
with heart attack decreased significantly overall (data not shown) and for all racial/ethnic
groups.
 Groups With Disparities: In 9 of 12 years, Black patients had lower inpatient mortality
rates than Whites for hospital admissions with heart attack.
■ The 2008 top 4 State achievable benchmark for inpatient heart attack mortality was 48
deaths per 1,000 admissions. By 2012, this benchmark had been attained overall and for
all racial/ethnic groups.
■ Because the 2008 benchmark was achieved by the total population, a new 2012 top 4
State achievable benchmark was set at 41 deaths per 1,000 admissions. The top 4 States
that contributed to the achievable benchmark are Alaska, Arizona, Michigan, and Rhode
Island.
■ Blacks have already achieved the benchmark. At current rates of improvement, Whites
could achieve the benchmark in a year and Hispanics in less than a year.
Inpatient deaths per 1,000 adult hospital admissions with heart attack, by
race/ethnicity, 2001-2013
0
20
40
60
80
100
120
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Rateper1,000Admissions
Denominator: Adults age 18 and over admitted to a non-Federal community hospital in the United States with acute myocardial infarction as
principal discharge diagnosis.
Note: For this measure, lower rates are better. Rates are adjusted by age, major diagnostic category, all payer refined-diagnosis related group
risk of mortality score, and transfers into the hospital. Black and White are non-Hispanic. Hispanic includes all races.
2012 Achievable Benchmark: 41 Deaths per 1,000 Admissions
Inpatient deaths per 1,000 adult hospital admissions with heart attack, by
race/ethnicity, 2001-2013
0
20
40
60
80
100
120
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Rateper1,000Admissions
Denominator: Adults age 18 and over admitted to a non-Federal community hospital in the United States with acute myocardial infarction as
principal discharge diagnosis.
Note: For this measure, lower rates are better. Rates are adjusted by age, major diagnostic category, all payer refined-diagnosis related group
risk of mortality score, and transfers into the hospital. Black and White are non-Hispanic. Hispanic includes all races.
2012 Achievable Benchmark: 41 Deaths per 1,000 Admissions

AHRQ Health Care Innovations in Cardiovascular Disease
Aetna’s Racial and Ethnic Equality Initiative
 Population: Black Aetna members
 Location: All 50 States
 Intervention: Disease management program targeting Blacks that combines home blood
pressure monitoring with culturally appropriate counseling and education.
 Outcomes: Significantly improved self-monitoring and blood pressure control.
Care for Substance Use Disorders
■ Mortality statistics for the United States did not identify Blacks separately, and until
1976, most other common measures of alcohol-related problems such as arrest and
hospital discharge rates did not provide a Black identifier. The 1979 National Institute on
Alcohol Abuse and Alcoholism National Survey indicated that based on self-reported
data, Black American males age 18 and over had higher levels of heavy drinking and
higher rates of alcohol-related problems than nonminorities.
■ Results from the 1983 single-room occupancy hotels study of drug abuse in New York
City suggested that Blacks had higher rates of drug use than Whites for marijuana,
cocaine, heroin, and illicit methadone.
■ Lung and esophageal cancer morbidity and mortality rates, known to be related to
smoking, were lower for Blacks than for Whites.
Care for Substance Use Disorders for Blacks
Measure
Most Recent
People age 12 and over who received any illicit drug or
alcohol abuse treatment in the last 12 months
Same No Change
People age 12 and over who needed treatment for illicit
drug use or an alcohol problem and who received such
treatment at a specialty facility in the last 12 months
Same No Change
People age 12 and over treated for substance abuse who
completed treatment course
Same No Change
 Trends: No measure of care for substance use disorders was improving for Blacks.
 Groups With Disparities: Blacks and Whites had similarly low rates of treatment for
substance use disorders.

Treatment for Illicit Drug Use or Alcohol Problem
 Overall Rate: In 2013, only 10.9% of people age 12 and over who needed treatment for
illicit drug use or an alcohol problem received such treatment at a specialty facility in the last
12 months.
 Groups With Disparities: From 2010 to 2013, there were no statistically significant
differences by race. In 2013, there was no statistically significant difference between Blacks
and Whites at any educational level.
the achievable benchmark are Alabama, Alaska, Delaware, Maryland, Oregon, and Utah.
■ The total population, Blacks, and Whites are making no progress toward the benchmark.
People age 12 and over who needed treatment for illicit drug use or an alcohol
problem and who received such treatment at a specialty facility in the last 12 months,
by race, 2010-2013, and by race stratified by education, 2013
0
5
10
15
20
25
2010 2011 2012 2013
Percent
Total White Black
0
5
10
15
20
25
<High School High School
Grad
Any College
Percent
Total White Black
Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2010-2013.
Denominator: Civilian noninstitutionalized population age 12 and over who needed treatment for illicit drug use or an alcohol problem.
Note: Treatment refers to treatment at a specialty facility, such as a drug and alcohol inpatient and/or outpatient rehabilitation facility, inpatient
hospital setting, or mental health center.
People age 12 and over who needed treatment for illicit drug use or an alcohol
problem and who received such treatment at a specialty facility in the last 12 months,
by race, 2010-2013, and by race stratified by education, 2013
0
5
10
15
20
25
2010 2011 2012 2013
Percent
Total White Black
0
5
10
15
20
25
<High School High School
Grad
Any College
Percent
Total White Black
Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2010-2013.
Denominator: Civilian noninstitutionalized population age 12 and over who needed treatment for illicit drug use or an alcohol problem.
Note: Treatment refers to treatment at a specialty facility, such as a drug and alcohol inpatient and/or outpatient rehabilitation facility, inpatient
hospital setting, or mental health center.

Completion of Substance Abuse Treatment
 Overall Rate: In 2011, 43.7% of people age 12 and over treated for substance abuse
completed their treatment course.
■ In 4 of 7 years, Blacks who were treated for substance abuse were significantly less likely
than Whites to complete treatment.
■ There were no statistically significant differences in treatment completion between
Blacks and Whites in the 3 most recent years, 2009-2011.
the achievable benchmark are Colorado, Connecticut, District of Columbia, Mississippi,
and Texas.
■ No group showed progress toward the benchmark.
People age 12 and over treated for substance abuse who completed
treatment course, by race/ethnicity, 2005-2011
0
20
40
60
80
100
2005 2006 2007 2008 2009 2010 2011
Percent
Source: Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set, Discharge Data Set, 2005-2011.
Denominator: Discharges age 12 and over from publicly funded substance abuse treatment facilities.
People age 12 and over treated for substance abuse who completed
treatment course, by race/ethnicity, 2005-2011
0
20
40
60
80
100
2005 2006 2007 2008 2009 2010 2011
Percent
Source: Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set, Discharge Data Set, 2005-2011.
Denominator: Discharges age 12 and over from publicly funded substance abuse treatment facilities.

Care for Diabetes
 Thirty years ago, the Heckler Report found:
■ Prevalence of diabetes was 33% higher in the Black population than in the White
population. Diabetes prevalence for Black females was 50% greater than for White
females.
■ Although diabetes accounts for less than 2 percent of male excess deaths and 5 percent of
female excess deaths (to age 70), it is a major risk factor for heart disease and leads to
other serious consequences, including amputation and blindness, if uncontrolled.
Diabetes Care for Blacks
Measure
Most Recent
Adults age 40 and over with diabetes whose condition was
diagnosed
Same Worse
Adults age 40 and over with diagnosed diabetes who
received all four recommended services for diabetes in the
calendar year
Worse No Change
Adults age 40 and over with diagnosed diabetes with
hemoglobin A1c under control
Same Insufficient Data
Adults age 40 and over with diagnosed diabetes with blood
pressure under control
Worse No Change
 Trends: Measures of diabetes care were not improving for Blacks.
■ After diagnosis, Blacks were less likely than Whites to receive recommended services for
diabetes and this disparity was not changing over time.
■ Blacks diagnosed with diabetes were less likely than Whites to have their hemoglobin
A1c and blood pressure under control and this disparity was not changing over time.

Recommended Services for Diabetes
 Importance:
■ Regular hemoglobin A1c (HbA1c) tests, foot exams, dilated eye exams, and flu shots
help people keep their diabetes under control and avoid diabetic complications.
■ A composite measure is used to track the national rate of receipt of all four of these
recommended annual diabetes interventions.
 Trends:
■ From 2008 to 2013, among adults age 40 and over with diagnosed diabetes, there were no
statistically significant improvements overall or among any racial groups.
■ In 2013, overall, Blacks were less likely than Whites to receive the recommended
services. Among adults age 60 and over, Blacks were also less likely than Whites to
receive the recommended services.
■ In 2013, among Black adults, those ages 40-59 were less likely than those age 60 and
over to receive the recommended services (13.7% compared with 22.3%).
Adults age 40 and over with diagnosed diabetes who reported receiving four
recommended services for diabetes in the calendar year, by race, 2008-2013, and by
race stratified by age, 2013
0
10
20
30
40
50
2008 2009 2010 2011 2012 2013
Percent
Total White Black
0
10
20
30
40
50
40-59 60+
Percent
2013
White Black
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2008-2013.
Denominator: Civilian noninstitutionalized population with diagnosed diabetes, age 40 and over.
Note: Data include people with both type 1 and type 2 diabetes. The four recommended services are 2+ hemoglobin A1c tests, foot exam,
dilated eye exam, and flu shot. Rates are age adjusted to the 2000 U.S. standard population using two age groups: 40-59 and 60 and over.
Adults age 40 and over with diagnosed diabetes who reported receiving four
recommended services for diabetes in the calendar year, by race, 2008-2013, and by
race stratified by age, 2013
0
10
20
30
40
50
2008 2009 2010 2011 2012 2013
Percent
Total White Black
0
10
20
30
40
50
40-59 60+
Percent
2013
White Black
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2008-2013.
Note: Data include people with both type 1 and type 2 diabetes. The four recommended services are 2+ hemoglobin A1c tests, foot exam,
dilated eye exam, and flu shot. Rates are age adjusted to the 2000 U.S. standard population using two age groups: 40-59 and 60 and over.

Written Diabetes Management Plans
 Importance:
■ A successful partnership for diabetes care requires providers to educate patients about
daily management of their diabetes. Therefore, providers should develop a written
diabetes management plan, especially for patients with a history of uncontrolled diabetes.
■ National data on diabetes management and outcomes for some underserved populations
are not available from the national data sources in the QDR. These populations include
people with limited English proficiency; individuals who speak a language other than
English at home; and Black subpopulations. To address some of these data gaps, we show
additional data from the California Health Interview Survey.
 Overall Rate: Only 43% of Californians with current diabetes had a written diabetes
management plan in 2011-2013.
 Groups With Disparities: Among Black Californians with diabetes, those who were poor
were less likely than those with middle and high income to have a written diabetes
management plan.
Adults with current diabetes who have a written diabetes management plan,
by race and race stratified by income, California, 2011-2013 combined
0
20
40
60
80
100
2011-2013
Percent
Total White Black
Asian AI/AN >1 Race
0
20
40
60
80
100
Poor Low
Income
Middle
Income
High
Income
Percent
2011-2013
White Black
Source: UCLA, Center for Health Policy Research, California Health Interview Survey, 2011-2013.
Denominator: Civilian noninstitutionalized population in California.
Note: Poor refers to family income below 100% of the Federal poverty level (FPL); low income refers to income of 100% to 199% of the FPL;
middle income refers to income of 200% to 399% of the FPL; and high income refers to income of 400% of the FPL and above. These are
based on U.S. census poverty thresholds.
Adults with current diabetes who have a written diabetes management plan,
by race and race stratified by income, California, 2011-2013 combined
0
20
40
60
80
100
2011-2013
Percent
Total White Black
Asian AI/AN >1 Race
0
20
40
60
80
100
Poor Low
Income
Middle
Income
High
Income
Percent
2011-2013
White Black
Source: UCLA, Center for Health Policy Research, California Health Interview Survey, 2011-2013.
Denominator: Civilian noninstitutionalized population in California.
Note: Poor refers to family income below 100% of the Federal poverty level (FPL); low income refers to income of 100% to 199% of the FPL;
middle income refers to income of 200% to 399% of the FPL; and high income refers to income of 400% of the FPL and above. These are
based on U.S. census poverty thresholds.

Adults With Diabetes With Hemoglobin A1c and Blood Pressure Under Control
 Importance: People diagnosed with diabetes are often at higher risk for cardiovascular
conditions, such as high blood pressure. Having these conditions in combination with
diagnosed diabetes increases the likelihood of complications, such as heart and kidney
diseases, blindness, nerve damage, and stroke. Patients who manage their diagnosed diabetes
and maintain an HbA1c level <8% and blood pressure <140/80 mm Hg can decrease these
risks.
 Overall Rate: In 2011-2012, among adults age 40 and over with diagnosed diabetes, 69.2%
achieved HbA1c less than 8% and 68.5% achieved blood pressure less than 140/80 mm Hg.
■ In 2003-2006, Blacks and Mexican Americans were less likely than Whites to have their
HbA1c under control. Differences in 2007-2010 and 2011-2012 were not statistically
significant.
■ In 2007-2010 and 2011-2012, Blacks were less likely than Whites to have their blood
pressure under control.
Adults age 40 and over with diagnosed diabetes with hemoglobin A1c and
blood pressure under control, by race/ethnicity, 2003-2006, 2007-2010, and
2011-2012
50
60
70
80
90
100
2003-2006 2007-2010 2011-2012
Percent
Hemoglobin A1c <8.0%
Total White
Black Mexican American
50
60
70
80
90
100
2003-2006 2007-2010 2011-2012
Percent
Blood Pressure <140/80 mm Hg
Total White
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey,
2003-2006, 2007-2010, and 2011-2012.
Note: Age adjusted to the 2000 U.S. standard population using two age groups: 40-59 and 60 and over.
Adults age 40 and over with diagnosed diabetes with hemoglobin A1c and
blood pressure under control, by race/ethnicity, 2003-2006, 2007-2010, and
2011-2012
50
60
70
80
90
100
2003-2006 2007-2010 2011-2012
Percent
Hemoglobin A1c <8.0%
Total White
50
60
70
80
90
100
2003-2006 2007-2010 2011-2012
Percent
Blood Pressure <140/80 mm Hg
Total White
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey,
2003-2006, 2007-2010, and 2011-2012.
Note: Age adjusted to the 2000 U.S. standard population using two age groups: 40-59 and 60 and over.

Outcomes of Diabetes Care for Blacks
Measure
Most Recent
Disparity
Disparity
Change
Admissions for uncontrolled diabetes without complications
per 100,000 population, age 18 and over
Worse No Change
Admissions with diabetes with short-term complications per
100,000 population, age 18 and over
Worse Narrowing
Admissions with diabetes with short-term complications per
100,000 population, ages 6-17
Worse No Change
Admissions with diabetes with long-term complications per
100,000 population, age 18 and over
Worse No Change
Adjusted incident rates of end stage renal disease (ESRD)
due to diabetes per million population
Worse Narrowing
 Trends: Less than half of outcomes of diabetes care for Blacks were improving.
■ Blacks had higher rates of admission than Whites for uncontrolled diabetes and for long-
term complications of diabetes. These disparities did not change over time.
■ Black adults had higher rates of admission than Whites for admission for short-term
complications of diabetes but the disparity was narrowing over time.
■ Black children had higher rates of admission for short-term complications than White
children and this disparity was not changing over time.
■ Blacks had higher rates of ESRD due to diabetes than Whites and this disparity was
narrowing over time.

Hospital Admissions for Uncontrolled Diabetes Without Complications
 Importance:
■ Individuals who do not achieve good control of their diabetes may develop symptoms
that require correction through hospitalization.
■ Admission rates for uncontrolled diabetes may be reduced by better outpatient treatment
and patients’ tighter adherence to the recommended diet and medication.
 Trends:
■ The rate of hospital admissions for uncontrolled diabetes without complications per
100,000 population decreased from 27.2 in 2001 to 15.4 in 2013.
■ From 2001 to 2013, the rate of hospital admissions per 100,000 population decreased for
all populations:
 For Blacks, from 88.3 to 45.3.
 For Whites, from 17.6 to 10.3.
 For APIs, from 14.2 to 5.9.
 For Hispanics, from 46.0 to 21.7.
Hospital admissions for uncontrolled diabetes without complications per
100,000 population, age 18 and over, by race/ethnicity, 2001-2013
Key: API = Asian or Pacific Islander
Note: For this measure, lower rates are better. Rates are adjusted by age and gender using the total U.S. resident population for 2010 as the
standard population; when reporting is by age, the adjustment is by gender only.
0
20
40
60
80
100
120
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Total White Black API Hispanic
2008 Achievable Benchmark: 5 per 100,000 Population
Hospital admissions for uncontrolled diabetes without complications per
100,000 population, age 18 and over, by race/ethnicity, 2001-2013
Key: API = Asian or Pacific Islander
Note: For this measure, lower rates are better. Rates are adjusted by age and gender using the total U.S. resident population for 2010 as the
standard population; when reporting is by age, the adjustment is by gender only.
0
20
40
60
80
100
120
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Total White Black API Hispanic
2008 Achievable Benchmark: 5 per 100,000 Population

 Groups With Disparities: In all years, the rate of hospital admissions for uncontrolled
diabetes was higher for Blacks and Hispanics compared with Whites.
■ The 2008 top 4 State achievable benchmark was 5 admissions per 100,000 population age
18 and over. The top 4 States that contributed to the achievable benchmark are Colorado,
Hawaii, Utah, and Vermont.
■ At the current rate, the benchmark could not be met for the total population for
approximately 16 years.
■ At the current rates, both Whites and Blacks would need 15 years to reach the
benchmark. Hispanics could reach the benchmark in less than 8 years and APIs in less
than 3 years.
Hospital Admissions for Uncontrolled Diabetes Without Complications, Stratified by Income
 Importance:
■ Individuals who do not achieve good control of their diabetes may develop symptoms
that require correction through hospitalization.
Hospital admissions for uncontrolled diabetes without complications
per 100,000 population, age 18 and over, by race/ethnicity stratified
by income, 2013
0
15
30
45
60
75
Code of residence.
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, State Inpatient Databases, 2013 quality and
disparities analysis file and AHRQ Quality Indicators, modified version 4.4.
Note: For this measure, lower rates are better.
Rates are adjusted by age and gender using the total U.S. resident population for 2010 as the standard population; when reporting is by age,
the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.
2008
Achievable
Benchmark: 5
per 100,000
Population
Hospital admissions for uncontrolled diabetes without complications
per 100,000 population, age 18 and over, by race/ethnicity stratified
by income, 2013
0
15
30
45
60
75
Code of residence.
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, State Inpatient Databases, 2013 quality and
disparities analysis file and AHRQ Quality Indicators, modified version 4.4.
Note: For this measure, lower rates are better.
Rates are adjusted by age and gender using the total U.S. resident population for 2010 as the standard population; when reporting is by age,
the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.
2008
Achievable
Benchmark: 5
per 100,000
Population

■ Admission rates for uncontrolled diabetes may be reduced by better outpatient treatment
and patients’ tighter adherence to the recommended diet and medication.
 Groups With Disparities: The rate of hospital admissions for uncontrolled diabetes was
higher for Blacks in the highest income quartile compared with Whites in the lowest income
quartile.
■ The 2008 top 4 State achievable benchmark was 5 admissions per 100,000 population age
18 and over. The top 4 States that contributed to the achievable benchmark are Colorado,
Hawaii, Utah, and Vermont.
■ No group has reached the benchmark.
New Cases of End Stage Renal Disease Due to Diabetes
 Importance: Diabetes is the most common cause of kidney failure. Keeping blood glucose
levels under control can prevent or slow the progression of kidney disease. When kidney
disease is detected early, medication can slow the disease’s progress; when detected late, it
commonly progresses to end stage renal disease requiring dialysis or kidney transplantation.
While some cases of kidney failure due to diabetes cannot be avoided, other cases reflect
New cases of end stage renal disease due to diabetes, per million population,
by ethnicity, 2003-2013
0
100
200
300
400
500
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
RateperMillionPopulation
Total White Black Asian AI/AN
2008 Achievable Benchmark: 90 per Million Population
Source: National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Renal Data System, 2003-2013.
Denominator: U.S. resident population.
Note: For this measure, lower rates are better. Rates are adjusted by age, sex, and interactions of age and sex. Adjusted rates use the 2011
ESRD cohort as reference.
New cases of end stage renal disease due to diabetes, per million population,
by ethnicity, 2003-2013
0
100
200
300
400
500
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
RateperMillionPopulation
Total White Black Asian AI/AN
2008 Achievable Benchmark: 90 per Million Population
Source: National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Renal Data System, 2003-2013.
Denominator: U.S. resident population.
Note: For this measure, lower rates are better. Rates are adjusted by age, sex, and interactions of age and sex. Adjusted rates use the 2011
ESRD cohort as reference.

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